The truth about “privatisation” and why government is a risky business - 23 February 2012

Opponents of the Bill frequently accuse the government of wanting to privatise the NHS. Just in case there’s any doubt, we are not privatising the NHS. This Bill is not about privatising the NHS.

The NHS is, and will always be, a universal service that’s free at the point of need. As we’ve reiterated in the first clause of the Bill itself, NHS services must be free of charge.

The message isn’t getting across and it’s easy to see why. The most vehement opponents of the Bill muddy concerns about competition, implying that there’s some kind of conspiracy to sell off the NHS to the private sector.

This isn’t what we’re doing. Yes, we think there are areas where competition, within the NHS and from the voluntary sector as well as private companies could improve the quality of care. But that’s the same position held by the previous Government and it’s not privatisation.

Charities or social enterprises run by health and care professionals – and indeed, some private sector providers – can sometimes be better placed to offer very specialist support that some patients need.

People treated at the Eastbourne Wound Healing Centre – a company set up by a nurse and an occupational therapist – have often had wounds that haven’t healed over three years. More than eight out of ten of them have their wounds healed in just 6 weeks. It’s one of the best clinics of its kind in the country. Whizz Kidz, a charity and social enterprise, has dramatically improved wheelchair services for disabled children.

We’d like to see more services like this, because it will help us drive up quality and it’s the most effective way we can offer patients some kind of meaningful choice about where and when they’re treated.

But we’ve added some important safeguards. GPs won’t be able to nudge patients towards the organisation that offers the lowest price, for example, because, under the Bill, organisations will compete on quality, not price.

Private companies won’t be able to “cherry pick” the services that are easy to deliver, leaving the NHS picking up the bill for more complex treatment because our legislation is makes pricing fairer and more transparent.

And as I pointed out in last week’s post, the Bill prevents discrimination in favour of private health companies over the NHS – because we don’t want a repeat of the mistakes made with independent sector treatment centres.

I’m happy to discuss competition in the NHS – it’s a legitimate andimportant area of debatethat ignites strong feeling. But let’s leave behind this idea that we’re hell-bent on privatising the NHS. It isn’t true, and it gets in the way of the much more meaningful discussion around the role of competition in the NHS both now and in the future.

Being in government is a risky business

Today, the House of Commons will debate a motion asking for the Department of Health to release its risk register on the reforms.

It’s part of a ongoing argument on whether government departments should have to disclose their risk registers – something that governments of all political persuasions have largely refused to do in the past.

A risk register is not a forecast or a prediction. It’s where civil servants contemplate the most extreme consequences of any major government project. They think the unthinkable to ensure that the unthinkable never happens.

The consequence of this – as for any major government project that’s being properly managed – is a paper trail which details some of the most outlandish and extreme possibilities that civil servants have contemplated. Contemplated, I stress, not forecasted.

As Lord Butler pointed out in the House of Lords last year, if government departments were forced to publish such information, many civil servants would be reluctant to jeopardise a policy they are working on by using language that could be sensationalised or cause embarrassment if made public.

They will simply stop writing the important stuff down – only the most anodyne and vague statements will ever be recorded. And a risk register that’s FOI proofed will be very little use to anyone.

As a minister, I want the civil servants I work with to be frank with me. If I’m asked to make a decision, I want to know that every angle has been covered – and yes, that might mean thinking through the most extreme and unlikely consequences any change in government policy might have.

Anything that inhibits civil servants from doing this will lead to poorer policy- making and poorer risk management.